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Trust or trash? Just what can you believe?

The annual KC Breed Health Coordinator (BHC) Symposium was, for the first time, opened up to people who are not BHCs. As a result, around 200 people attended the event which featured a packed agenda of topics. There has already been an overview of the day published in Our Dogs (13/10/17) but, this month, I want to focus on one of the sessions I found particularly interesting.

“Sniffing out the science – how to interpret information on dog health”, was presented by Dr Zoe Belshaw from the Centre for Evidence Based Veterinary Medicine at Nottingham University. I am an avid searcher for, and reader of, scientific papers and other published information on canine (and human) health and genetics. There are a couple of basic challenges; knowing where to look and knowing what to believe. Remember, we are increasingly living in a world where so-called Fake News pops up, especially via social media. Zoe’s presentation addressed both of the challenges. Let’s start with knowing what to believe.

Almost every day, new scientific papers are published or there’s a blog post (often cross-posted onto Facebook or Twitter) with a mix of data, evidence, insights and opinions. There is ALWAYS a risk of bias in these; every author brings their own agenda. As readers, we also bring our own biases and I’ve written before about Cognitive Dissonance. For example, many people simply look for information that supports their existing opinions and tend to reject anything that goes against that opinion.

Another reality of published information is that there may well be different conclusions drawn about the same issue. That might be a result of bias or it might be related to the methodology used by the author in their study. An obvious example would be the different results published by Dan O’Neill’s VetCompass project compared with results from a Breed Club’s Health Survey. The two sample populations are completely different. VetCompass data comes from first opinion vets using standard VeNom classification codes for different health conditions. Many breed surveys will not use those codes; they may use categories that reflect terms in common use by “ordinary” owners. The population being sampled is also likely to be different; mostly breeders and exhibitors. It might therefore not be surprising for VetCompass to find the most prevalent diagnoses are Otitis, Dental disease, Anal sac impaction and overgrown nails, whereas a breed survey may be more likely to find issues such as PRA, epilepsy or allergies. They are both “right”, based on the methodology and the sample. In my breed, our Health Committee has always taken the view that we need to triangulate in on priority health issues by using a variety of evidence sources. As we find new information from different sources, we can tweak our approach and our priorities. For example, we amended some of the categories and conditions we list in our ongoing health survey as a result of the 2014 KC survey.

The Trust Triangle

Zoe talked about the Trust Triangle which describes the different types of information you might come across and the levels of trust that can be associated with each.

At the bottom of the Trust Triangle are non-experts with opinions. Facebook and social media are awash with these! Journalists and experts with a commercial interest also fall into this category. Next comes expert opinion; these are people who are widely acknowledged to be experts in their field. Many of them will know an awful lot about a very narrow field of science. They too come with their biases and personal agendas but, mostly, they will have years of experience and scientific data to back up their opinions. Moving up the Trust Triangle, we find primary scientific research. This is made public via “papers”, the best of which will be peer-reviewed, rigorous, well-reported and independent. At the pinnacle of trustworthy published scientific research are papers that present systematic reviews of multiple other studies. These publications dissect and critique a set of primary research papers in order to arrive at “the best evidence” to support a particular case (or to disprove it). This is the sort of work that Zoe’s colleagues do at the Nottingham Centre for EBVM and they then publish what can be considered to be best practice for vets and clinicians to adopt. As with all science, “best practice” today could well change if new research evidence emerges. A topical example is vaccination protocols where advice from WSAVA should have moved vets away from “annual boosters” of core vaccines to a less frequent regime (no more frequent than every 3 years, generally) or the use of titre testing to assess levels of immunity.

One potential issue with the Trust Triangle is that, the higher up you go, the less accessible the information becomes and, often, it also becomes more difficult to interpret and understand. At the base of the triangle, keyboard warriors and instant experts often use language pitched at a level that you’d expect to find in the Daily Mail (or Beano). At the top of the triangle, the language is (rightly) riddled with scientific terminology and often supported by statistical analysis that is impenetrable to the ordinary dog owner or breeder. Those of us who are interested in this material may need help from subject matter experts to interpret it and clarify the meaning so we can share it with other owners. The KC’s Health team and other Breed Health Coordinators with science, veterinary or research backgrounds are invaluable in this respect. Most BHCs will also have built a network of trusted specialist advisors to whom they can turn for advice when a new paper is published. We should be hugely grateful that people like Cathryn Mellersh, Dan O’Neill, Clare Rusbridge and Sheila Crispin, to name but a few, are so generous with their time and support to our breeds.

There’s a useful resource which Zoe pointed us at to help decide if we should “Trust it or trash it” (trustortrash.org). This takes you through a series of questions to identify: who said it, when they said it and how they know it. She also gave examples of good ways and places to find the information we need to support the development of breed health improvement strategies. These include Google Scholar, RCVS Knowledge, PubMed, BestBETS for Vets and VetSRev.

As champions of breed health improvement, BHCs can make good use of social media to communicate with owners. It enables them to reach a wide audience, for example through breed-specific Facebook Groups. What they communicate, however, needs to be distilled from evidence sources higher up the Trust Triangle.